Vardhman Mahavir Medical College and Safdarjung Hospital

PHYSIOLOGY (Paper I)

Paper I (Unit 4)
CARDIOVASCULAR PHYSIOLOGY
Type I Questions : Explain the following / Give Reason.

1. Explain why, physiology delay is considered to be beneficial.

2. Explain why, blood pressure falls on standing.
3. Explain why, decreased heart rate is observed in atheletes.
4. Explain why, dopamine is the preferred drug to treat haemorrhagic
shock.
5. Explain why, isometric exercise should be avoided in hypertensive
patients.
6. Explain why, tachycardia is the associated fever in most types of fever.
7. Explain why, subendocardial portion of left ventricle is very prone to
ischaemia.
8. Explain why, cardiac muscle cannot be tetanised.
9. Explain why, the ECG waves are predmoninantly negative in aVR lead.
10. Explain why, R wave and T wave have same polarity in ECG.
11. Explain why, diastolic BP may fall in severe grade isotonic exercise.
12. Explain why, heart acts as syncytium.
13. Explain why, ACE inhibitors are used in the treatment of hypertension.
14. Explain why, there are phasic changes in coronary circulation.
15. Explain why, there is bradycardia in a patient suffering from raised
intracranial tension.
16. Explain why, dilated heart has to do more work than non-dilated heart.
17. Explain why, blood flow in muscle increases before start of exercise.
18. Explain why, low dose of aspirin is given to prevent Angina.
19. Explain why, Koratkoff’s sounds are heard.
20. Explain why ST segment is elevated in MI.
21. Explain why, both diastolic and systolic blood pressure increase with age.
22. Explain why EEG waves are inverted in the lead aVF.
 23. Explain why, digitalis is positively ionotropic.
24. Explain why, systolic BP is markedly increased whereas diastolic BP
either remains unchanged or falls after strenuous exercise.
25. Explain why, Q wave is negative, R wave is positive and S wave is
negative in classical limb leads.
26. Explain why, IV injection of adrenaline decreases PR interval whereas IV
injection of Noradrenlaine increases PR interval.
27. Explain why, IV injection of adrenaline increases heart rate but IV
injection of noradrenaline decreases Heart Rate.
28. Explain why, cardiac muscle is a functional syncytia.

Type II Qustions : Flow Chart / Diagram Based Questions

1. Draw a labelled diagram to illustrate : ECG in lead aVR.

2. Draw labelled diagrams of – Changes in left ventricular pressure, left atrial pressure,
aortic pressure, ventricular volume ECG and phonocardiogram during different
phases of cardiac cycle.
Type III Questions : Short Notes

1. Differentiate between first and second heart sound. (3m,2019)

2. Differentiate between Hypovolemic Shock and Septic Shock. (3m,2019)
3. Differentiate between Cardiogenic and Hypovolemic Shock. (3m,2015)
4. Differentiate between Distributive and Hypovolemic Shock. (3m,2014)
5. Differentiate between SA Node potential and ventricular action (3m,2019)
potential.
6. Write short note on : Effect of endurance training on Cardiovascular (3m,2019)
system.
7. Write short notes on : Blood Pressure changes during exercise. (3m,2012)
8. Write short note on Cardiogenic Shock. (3m,2018)
9. Write short note on Haemorrhagic Shock. (3m,2013)
10. Write short note on : Function of Baroreceptors. (3m,2019)
11. Write a short note on : Reynold’s Number (3m,2017)
12. Write short note on : regulation of Cardiac Output. (3m,2015)
13. Write short note on : Heterometeric Regulation of Cardiac Output. (3m,2010)
14. Write short note on : regulation of Heart Rate. (3m,2014)
15. Discuss briefly the factors regulating coronary blood flow. (3m,2014)
16. Describe short term regulation of arterial pressure. (6m,2019)
17. Describe briefly the short term regulation of Blood Pressure. (6m,2013)
18. Discuss the factors affecting Cardiac Output. Explain Fick’s method for (6m,2018)
measurement of Cardiac Output.
19. Describe in brief the regulation of Cardiac Output. (6m,2016)
20. Describe briefly the regulation of cardiac output. How it is determined (6m,2012)
? (Name the methods)
21. Discuss briefly the role of baroreceptors in regulation of blood pressure. (6m,2015)
22. Describe the role of Nitric Oxide in Cardiovascular system. (Imp)
Type IV Questions : Long Answer Type Questions

1. List the factors affecting resting Heart Rate (HR). Describe the regulation of heart rate.

2. Define Cardiac Output. Describe its regulation in detail. Elaborate the various methods
to determine cardiac output. List two physiological conditions in which cardiac output
may be increased.
3. Describe the regulation of blood pressure. Highlight the significance if Baroreceptors
in regulating BP.
4. Define mean blood pressure. Name the determinants of arterial blood pressure.
Describe briefly the long term regulation of blood pressure.
5. Enumerate the various types of Shock. Explain the different types of mechanisms
occurring in hypovolemic shock.

Type V Questions : Case Based Questions

1. A 40-year-old man arrived by ambulance at an emergency department after a road

traffic accident, causing the loss of about 1.5 L of blood, an estimated 30% of blood
volume. Bleeding was controlled by direct pressure, and the patient received 2 L of
0.9% saline during transport.
On physical examination:
Weak pulse,
RR 22/min and shallow,
BP 80/60 mm Hg
a) Define shock and enumerate the various types of shock.
b) Explain the compensatory mechanisms involved in, hypovolemic shock.

2. A 40- year-old male presented to the emergency to flowing a severe road traffic
accident. His blood pressure was 60/22 mm Hg, and his pulse was very rapid and
thready. He had rapid and shallow breathing. He was diagnosed to have haemorrhagic
shock.
a) Define and classify shock.
b) Describe the pathophysiology of haemorrhagic shock.
3. A 26-year-old unconscious male, victim of road traffic accident was brought to the
emergency. On examination, multiple fractures were found over his body, his BP was
64/40 mm Hg and heart rate was 150 bpm. His breathing was rapid and shallow, skin
was cold and he was responding to pain. Attending physician started the treatment for
haemorrhagic shock.
a) Explain pathophysiology of haemorrhagic shock.
b) Describe the compensatory mechanisms activated in body following this event.

4. A 25-year-old female developed septicemia following delivery of her first baby. It left
untreated, she is likely to develop shock.
a) Classify different types of shock.
b) Enumerate four features of the shock patient is likely to develop.

5. 50-year-old man is brought to emergency with acute chest pain and sweating. On ECG,
he is diagnosed as a case of myocardial infarction.
a) Enumerate the clinical information that can be derived from a normal ECG
b) Describe the classical findings of myocardial infarction in Lead I ECG.

6. A 21-year-old woman presents to her primary care physician because she wants to
begin an exercise program for weight loss. She is concerned because when she
exercised in the past, she noticed that her heart seemed to beat rapidly. After a
thorough physical examination, everything appears to be normal and the physician
reassures the patient.
a) Discuss the physiological basis of increased heart rate experienced by the lady
during exercise.
b) Explain how does muscle blood flow increase during exercise.

7. A 21-year-old woman presents to her primary care physician because she wants to
begin an exercise program for weight loss. She is concerned because when she
exercised in the past, she noticed that her heart seemed to beat rapidly. After a
thorough physical examination, everything appears to be normal and the physician
 reassures the patient that her increased heart rate is probably a normal response to
exercise.
a) What is the cause of increased heart rate during exercise?
b) How does muscle blood flow increase during exercise?
c) Briefly describe the various factors which lead to onset of fatigue.

8. A 20-year-old sedentary male goes to the gym first time. He finishes 5 miles in 15
minutes on treadmill.
a) Classify this physical activity as isotonic or isometric. Explain its effect on
cardiovascular system.
b) Enumerate four changes in respiratory system at the end of this activity.

9. A 68-year-old woman presents to the emergency centre with shortness of breath, light-
headedness, and chest pain. She is diagnosed with a myocardial infarction. Her heart
rate is 40 beats per minute (bpm). The patient is diagnosed with complete heart block,
probably as a result of her myocardial infarction. The patient is taken to the intensive
care unit for stabilization, and plans are made for pacemaker insertion.
a) Where is the normal pacemaker of heart located?
b) Why does this patient have bradycardia?
c) Which parts of the heart have the fastest and slowest conduction velocities?
d) Describe the ECG changes in a patient suffering from complete heart block.

10. A 50-year-old man is brought to emergency with acute chest pain and sweating . After
ECG, he is diagnosed as a case of myocardial infarction.
a) Describe the classical findings of myocardial infarction in Lead II ECG.
b) Describe the physiological basis of the changes observed in ECG, in this case.

AARYAN TYAGI
(MBBS 2019 Batch)
VMMC and Safdarjung Hospital